| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,911 |
6,295 |
$269K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,866 |
1,905 |
$182K |
| D0120 |
Periodic oral evaluation - established patient |
7,604 |
6,912 |
$153K |
| D0330 |
Panoramic radiographic image |
3,301 |
2,970 |
$150K |
| D0274 |
Bitewings - four radiographic images |
6,341 |
5,700 |
$132K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,752 |
819 |
$115K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,652 |
3,327 |
$104K |
| D0140 |
Limited oral evaluation - problem focused |
3,212 |
2,901 |
$82K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,119 |
776 |
$70K |
| D0220 |
Intraoral - periapical first radiographic image |
10,580 |
9,545 |
$63K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
814 |
588 |
$61K |
| D1120 |
Prophylaxis - child |
2,105 |
1,927 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,879 |
6,264 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,735 |
2,551 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
739 |
714 |
$35K |
| D1206 |
Topical application of fluoride varnish |
992 |
897 |
$26K |
| D2740 |
Crown - porcelain/ceramic |
21 |
17 |
$16K |
| D1351 |
Sealant - per tooth |
590 |
133 |
$12K |
| D0272 |
Bitewings - two radiographic images |
888 |
803 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
113 |
84 |
$6K |
| D2160 |
|
80 |
62 |
$5K |
| D2332 |
|
28 |
15 |
$4K |
| D2331 |
|
36 |
24 |
$3K |
| D2140 |
|
58 |
42 |
$2K |
| D2335 |
|
20 |
15 |
$2K |
| D2330 |
|
19 |
12 |
$921.78 |